D75. Trends In Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome in Rheumatoid Arthritis Patients

PURPOSE: Rheumatoid arthritis (RA) heightens the risk of Carpal Tunnel Syndrome (CTS) due to inflammation-induced compression of the median nerve. Surgical management, specifically Endoscopic CTR (ECTR) and open CTR (OCTR), is considered when conservative treatments prove ineffective. Our focus is on examining national trends, outcomes, and patient-specific comorbidities related to ECTR and OCTR in RA patients. METHODS: A retrospective cohort study was conducted using the PearlDiver database to identify RA patients who underwent ECTR and OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. Univariate and multivariate analysis assessed differences in outcomes and patient-specific comorbidities between the treatment methods. RESULTS: Patients with RA undergoing ECTR (n=683) showed no significant differences in medical comorbidities compared to those undergoing OCTR (n=4234), including hypertension, obesity, chronic kidney disease, hypothyroidism, and diabetes mellitus. However, the ECTR group had a higher risk ratio of 1.44 (CI: 1.10-1.89, p=0.01) for requiring a repeat procedure within 90 days of the initial one. Over five years, ECTR and OCTR procedures exhibited combined annual growth rates of 5.6% and 13.2%, respectively. CONCLUSION: Both RA and ECTR are known risk factors for revision CTR. Our study reveals a higher 90-day risk of repeat procedures in the ECTR group compared to OCTR. The increasing popularity of OCTR over ECTR may be attributed to the latter's association with higher revision rates. Revision following ECTR in RA patients might be linked to tenosynovitis-related technical challenges. Future research should delve into characterizing repeat procedures in this patient subset.